This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 12 September 2009

Uniforms Revisited

We do not have much in the way of changing facilities for staff at my hospital. I do know of some hospitals that do provide changing facilities so that staff do not need to come to and from work in their work wear. I know of more hospitals THAT DO NOT HAVE THESE FACILITIES.

There were two wards at my hospital that had changing rooms for staff. Now that my ward has been redone we have one. We begged and begged and begged to get a changing room. If there hadn't been a major structural problem we never would have had our ward redone. The numerous other wards/units at this hospital do not have changing facilities.

Let me tell you what staff on my ward were doing before we were refurbished recently. I am telling you this because many many staff are still going through this.

We were getting accosted and verbally assaulted by matron types/senior office types and members of the general public for travelling to and from work in uniforms.

But they still would not provide changing facilities.

So we had the bright idea of changing in the staff toilet (very small decrepit room) at the beginning and the end of our shifts. We got away with this for awhile. Then we were caught by the housekeeper who had a fit over the fact that we were changing in there. Those who were caught changing in the toilets got in trouble and the rest of us were warned. What to do, what to do. We were still getting verbally assaulted and threatened if seen travelling to and from work in uniform by morons who thinks that this will spread MRSA around.

So we had another bright idea. There was a small supply cupboard just near the toilets. This room was about 7 by 10 foot. When we came to work we snuck in there to change out of our street clothes and into our uniforms (which we carried to work in a shopping bag). There was no place to store our street clothes, shoes, belongings so they were left on the floor in carrier bags or hung on a hook in this shitty supply cupboard. The domestic supervisor and housekeeper again caught us changing in there and went to the matron or chief nurse to complain. Busted again. Threatened again and told that we are NOT to change in supply cupboards and toilets. But we were still being verbally assaulted when seen on our way to work in uniform.

In the summer we were sweating buckets on the way to and from work because we tried to hide our uniforms under long winter coats. And we were still getting the "tsk tsk, look at those nurses coming to and from work in their uniforms" by silly old ladies mostly. These same silly people will also see a beauty therapist walking through town in her uniform and says "tsk tsk, look at that nurse wearing her uniform".

Sometimes a matron or an office type would stop us and say something about being in uniform on our way to work, even though we tried to make them aware of the lack of facilities. They threatened us for coming to and from work in our uniforms. They threatened us for changing in toilets and supply cupboards. And they continued to ignore requests for staff changing facilities. Most of the nursing staff at my hospital are still going through this. Some wards have found little cupboards and closets near their units to change in. And they haven't been caught yet. The rest are trying to hide their uniforms under long heavy coats as they travel to work.

The supply cupboard and the toilets were our only option. The only other option would be to change in the middle of the ward. Should we sneak into the patient bathrooms perhaps? Luckily Nurse Anne and crew are in a better place now. Wish I could say the same thing for everyone else.

The reason I am telling you about this is because every time there is a news story about nurses and or infection control in hospitals there is always some idiot bleating on about the fact that he has seen staff travelling to and from work in uniform.

Don't assume that we have changing facilities or our uniforms laundered. That is a very fucking stupid assumption to make. Uniforms are not the big problem with infection control anyway. And even so, we can get uniforms that are made out of anti-microbial stuff.

Instead of pissing and moaning about stupid crap and verbally abusing nurses on the way to work (or hairdressers in uniforms that you mistake for nurses because you are a fucktwit) here are some things you can do if you are concerned about hospital bugs:

1. Demand that the hospitals actually hire cleaners that clean and are there for more than a few hours a day.

5. Stop transporters from dumping new patients into a bed that has only been vacated by a discharged patient moments ago. For fucks sake, allow us to clean the thing. If I am tied up with a sick patient I cannot leave him to clean the recently vacated bed. Hold your horses until I can do it or hire a cleaner to clean and prepare beds for the next patient. Fuck the targets.

6. Changing facilities for staff!! Proper laundering of our uniforms!! The hospital laundry will not touch our uniforms (if we send it through the hospital laundry it will be lost forever) and domestic household washing machines don't do the trick. But who cares. They need to be worrying about ratios, bed occupancy, and facilities before harping on about uniforms.

And yes, highly paid matrons really do hide behind trees to catch staff coming to and from work in uniforms. There are members of the public who think that they are doing some kind of good deed/community watch thing by looking for and targeting people on their way to work who appear to be in a nurse's uniform. Meanwhile no one, AND I MEAN NO ONE IN ANY KIND OF AUTHORITY POSITION is addressing the points I made above. Well, the RCN did for about 5 seconds a few years ago. The public doesn't address these issues either. I guess it's more fun to sit on your fat ass and say "these bloody slag nurses go on the bus in their uniforms and that is why we have MRSA". Idiots.

24 comments:

I should have mentioned all the injuries and embarrassments we had getting changed in a tiny closet where boxes of heavy equipment was stashed....and when someone would open to the door to come in there...everyone else in the main foyer got a view of you half dressed.

Sometimes a matron or an office type would stop us and say something about being in uniform on our way to work, even though we tried to make them aware of the lack of facilities. They threatened us for coming to and from work in our uniforms. They threatened us for changing in toilets and supply cupboards. And they continued to ignore requests for staff changing facilities.

So... your managers: (1) won't provide changing rooms (2) won't let you change in little private corners like toilets but (3) behave threateningly when you change at home and come to work in uniform and (4) ignore your requests for changing facilities. Given all these negatives, what do they actually suggest you do? If the answer to that question is "nothing" I suggest that you all start changing in corridors, ward offices and nurses' stations. Why not? Anyway, from what you've written you seem to have tried all the obvious places so where else is there? Naturally the local paper would soon find out what was going on... patients and relatives would complain...

Ridiculous suggestion? Well I don't think so but you might - what I find beyond ridiculous is the idea of spending all day in a uniform soiled with some or all of the following: blood, vomit, urine, faeces - and then having to wear the filthy thing home...

No the public berates nurses on the way to work in their uniforms. The public doesn't give a crap about whether or not we have changing facilities. Of course the powers that be will not make that info public because then people might blame them rather than the nurses.

As for individuals getting sacked for individual protests, well that happens, and then employers get taken to industrial tribunals and sometimes they win and sometimes they lose and have to pay compensation or reinstate their victim.

The important things are (1) follow grievance procedures to the end (2) if you are a union member make sure the union knows what you are doing and (3) don't act alone. So, while an individual nurse who decides to campaign for a changing room by changing at the nurses station is clearly vulnerable to disciplinary action, every nurse, in every ward, changing at the nurses' station, shift after shift is something else entirely. Anyway, from what you've written you have a sound defence: you have no changing facilities, you're not allowed to change in toilets or store rooms and you're not allowed to wear your uniforms outside the hospital, therefore you change at your workplace.

Anne, You are a saint for putting up with this horseshit! I'm starting to believe the UK does not deserve its nurses if this is the face-slapping they have to put up with. That and being put down for having a degree. I want my caregiver to be intelligent enough to hold a degree and know how to think critically. You and your fellow colleagues would be welcome in the States. Casey in the USA

By the way, nice piece in the Guardian. Please keep writing. Maybe you'll get through. I was, unfortunately, underwhelmed and unimpressed by the ignorance of many of those making comments. It appears to me that VERY FEW people in the UK know the responsibilities of nurses and are even more resistant to being educated on it! Disgusting! Keep pressing on. Eventually, it will make a difference. For what it is worth, you have a fan in the States. Casey in the USA

My tale may amuse you. I am a surgeon in a fairly clean sub speciality, but arrived in theatre the other day to find My shoes encrusted in dried blood, presumably by courtesy of one of my orthopedic colleagues. There was a time when the hospital cleaned the shoes, but this has been stopped as no longer acceptable on grounds of health and safety. Do I wear the shoes? Do I take them home andclean them in my utility room? Why is this less dangerous on health and safety grounds?

I borrowed some shoes, and the others are in a plastic bag in my car. Before anyone complains about nhs hospitals, this was at our private hospital...

Thanks everyone. Your comments are so helpful. If anyone (who isn't a nurse) is reading this, they will see that I am not a lone voice here. And yes... The guardian comments were disapointing. People disregarded what I was trying to tell them and stuck with their ignorant and prejudicial views. But I really appreciate the guardian for giving me a chance to get my views out there.

At least there are real journalists who want to hear from real nurses (not ones who have been retired since the 50's and don't understand the situation). It's good that they are trying to get BOTH sides of the story out there.

Glad you're back Nurse Anne.The uniform issue bugs me too. I see private nursing homes and their health care assistants out in uniform - usually fag in hand / dirty trainers = a nurse Carers from private agencies with face piercings and long painted bitch nails = nurse. The beauty therapists - well theirs are quite smart, good quality material and if they are white pristine. I'm envious of those. Domestics wear defunct nurses uniforms ipso facto must be a nurse. In a nutshell one big fat ol' mess.One thing is for certain the NMC, RCN, DoH will do nothing - productive ward anyone ?

"Carers from private agencies with face piercings and long painted bitch nails = nurse. The beauty therapists - well theirs are quite smart, good quality material and if they are white pristine. I'm envious of those. Domestics wear defunct nurses uniforms ipso facto must be a nurse. In a nutshell one big fat ol' mess"

I noticed this the other day, think it was someone working for a carers agency. Tunic, jeans, open toe shoes, bracelets, false nails, it goes on. As others have said, the general publc can't tell the difference between a nursery nurse and an itu nurse.

On the subject of members of the public stopping staff in their uniforms, one of my friends was souted at by a member of the public for being in uniform, her response, "I'm working in the community you niblock". These people seem to think its as simple as banning nurses from wearing uniform to and from work, its something I have to do because I'm not getting changed in the male staff toilet that stinks of stale urine. I'll take my chances on the bus thanks....

We had a visitor who came to see her relative. The relative was on precautions for cdiff. We explained about handwashing, isolation etc. The visitor visited the isolation patient and then noticed that she had some friends who were also patients on the ward. So she went to see them as well. She was sitting on the beds, shaking hands, getting snotty with the nurses when we told her that her behaviour was just going to spread infection around. She got pissy when she was asked her wash her hands.

Her response to us was "You bloody nurses shouldn't be wearing your uniforms to and from work".

"How are visitors/relatives supposed to know you don't hsve changing room facilities? Go to work each day in my uniform and have NEVER heard negative remarks.

Always met with this strange kind of regard"

I don't expect them to always know. I do expect them to not make dumbass ignorant assumptions based around the historical hangover prejudices that they have about nurses. They do this, they make this assumptions and then they get nasty with the nurses.

I am one of the lucky ones who *does* have a small, lockable changing room to change in and (limited) space in which to hang up my street clothes. However this is right next to our staff kitchen / break room and thanks to SHOs leaving scrubs on the floor and our general filthy habits (sorry, but some nurses/doctors in my department are rank) we now have an outbreak of mice AND flies!

I can see this facility being 'taken away' from us for 'abuse' at some point and know for a fact that most of the wards in my hospital do not have changing facilities.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.